ilovecornfields

Be careful. It is unlikely a physician would authorize her to fly with a bowel obstruction without an NG tube in place. ”It is important to remember that intestinal gas will expand 25% by volume at a cabin altitude of 8000 ft (2438 m). Post-abdominal surgery patients have a rela- tive ileus for several days, thereby putting them at risk for tearing of suture lines, bleeding, and perforation. In addition, stretching gastric or intestinal mucosa may result in hemorrhage from ulcer or suture sites. To be safe, air travel should be discouraged for 1-2 wk after the procedure. (The time could be reduced to 1 wk if the intestinal lumen was not opened.) Likewise, flight would be inadvisable for 24 h following a colonoscopy with a polypectomy procedure because of the large amount of gas still often present in the colon and the risk of unexpected bleeding from the polypectomy site. A patient with an asymptomatic partial small or large bowel obstruction may also be unable to accommodate the gastrointestinal gas expansion during a flight, and should be advised not to travel by air.” Source: https://www.asma.org/asma/media/asma/travel-publications/medguid.pdf

I’m sorry to hear about your mother. “Emergency surgery” and trips by Mooney don’t seem to go together very well. Hopefully you are making well-informed medical decisions.

@Junkman and @mike_elliott, you continue to impress me with your leadership and transparency throughout this process. Postponing an even that you have put your heart and soul into must have been gut wrenching but you are modeling the exact behavior that makes you such excellent educators and champions of safety. If only more pilots displayed this behavior more consistently I’m sure the GA accident rate would be much lower. You have my respect and admiration.

Or they just don’t. Minimal aerial efforts on thr Eastern side of the Tahoe fire. TVL is now closed and the entire South Lake Tahoe basin is under evacuation orders.

Would this work if you would expect to lose visual contact? For example, if the guy was on downwind and I said I had him in sight could they clear me to take off IFR knowing at at some point I would lose him, perhaps before he landed?

I did it last week. East of San Diego (Julian, Palm Springs) was pretty gross. LA Basin was pretty hazy but not too bad. SLO is clear. Smoke/haze tops seem to be around 8-11k so I just flew over the top, but then my passengers don’t mind oxygen. Don’t take this as medical advice, but sometimes taking a couple of puffs of the rescue inhaler (with spacer) before the flight can help. Hopefully it doesn’t make them too jittery.

Edit: My wife said the RV landed before we took off and when we disagree she’s right 99.9% of the time so I will change my answer to that.

I wish I’d paid more attention. I just wanted to get off the ground and keep the temps down so I wasn’t really focused on him. I wanted to say he was on downwind but it doesn’t sound like that would have been legal. This airport doesn’t have a LiveATC feed so I can’t go back and listen to the recording.

Thanks for all the responses. Makes sense now. I didn’t even think about requesting a SVFR departure although I assume I wouldn’t have been legal outside the Class D so I guess my only choice was to wait and get my IFR departure.

Interesting. I wish I’d paid more attention. It was at a Class D airport with nothing else nearby. I actually have no idea why it has a tower since much busier airports around it don’t. Is it common to request special VFR for pattern work? I don’t think I’ve ever seen it before.

So I took a quick trip up to the CA Central Valley and both my departure and destination were IMC (departure due to marine layer and destination due to smoke and haze). A couple of hours later I field IFR home but the oil temp was getting high (almost 100 F outside and it hadn’t cooled off from the last flight) so as I waiting for my IFR release and watching an RV in the pattern I told the tower we could depart VFR and pick up the clearance on the way. He replied “No you can’t. The field is IFR.” I got my release a few seconds later and took off but this makes no sense to me. If the field is IFR why is there an RV doing pattern work on the parallel runway? I guess you could ask for special VFR for pattern work but I was listening and never heard him ask or be cleared for this. What am I missing?

Didn’t mean to start the theoretical LOP vs ROP discussion (or talk about T&G or anything like that) I was just wondering if there were actual facts to supplement the theoretical discussion. Sometimes we focus on one variable and another confounding variable ends up actually being the cause. I took the APS class and drank the Kool-Aid. My engine just seems to run better ROP despite GAMI injectors, good plugs and a good spread. I’m usually not in a hurry to get anywhere so my temps are very reasonable. I guess I’d love to see data that shows that ROP engines run at the same temps have different outcomes than LOP engines. Maybe Savvy knows…

Maybe I’m confused but I thought TEC routes (published standard routes between two airports) and tower-to-tower clearances were two different things. As others have pointed out, the TEC routes are quite commonly used, especially in Southern CA and provide standard and predictable ways to go between two airports and in ForeFlight you can just file the TEC route “KSMX SBAP42 KHHR.” I have a vague memory (like over 25 years ago) of requesting a “tower-to-tower” IFR clearance which was basically an on-the-fly clearance from one tower to another without involving anyone else in the NAS. The tower at your departure airport would basically coordinate with your arrival airport (close by) and give you a route. I’ve done it VFR recently but I don’t think I’ve tried to do it IFR in a long time. Maybe one of the CA CFIs can clarify if there’s a difference or if I’m just confused.

Expert Aircraft at French Valley (F70) has done work on my Mooney and I’ve been very impressed. Not an MSC (I think they’re a Beechcraft Service Center or something like that) but very good. I think he used to work on fighters so he’s not intimidated by our fast Mooneys. Did an awesome job on the baffle seals, too.

Is there really a source for this? I have an IO-550 and have a friend with a Bonanza that also has an IO-550. In similar timeframes he’s replaced 4 cylinders and I have replaced none. He runs LOP (or used to until that 4th cylinder) and I run ROP. If there’s a definitive source that says that I “need to” run LOP I’d love to see it. I have nothing against LOP. I actually used it on my last flight to stretch the fuel reserve a little but that just seemed like a pretty strong statement to make and contrary to my experience.

And don’t forget Pokémon cards. They’re extremely scarce right now leading to rationing and gunfights. Just think of the children… https://www.fox6now.com/news/fight-over-trading-cards-outside-brookfield-target I know about as much about picking stocks as I do about engine overhauls. How would you rearrange a portfolio to account for the supply chain and labor issues?

Top Gun is in Stockton. If they can’t fix it for you it can’t be fixed (except fuel leaks, they don’t really like doing those). http://www.topgunaviation.net

I get it. Residency is hard. Back when I was a resident we had to walk uphill both ways to the hospital in the snow…and I trained in California. I was actually there during the change. It’s a appealing narrative to say that residents are just more efficient now and we were a bunch of inefficient troglodytes, but that’s a little disingenuous. The work has changed. Things that residents used to do are now done by more residents, attendings and to a large extent mid-level providers. When I trained you would never see PAs or NPs in the hospital and now they’re all over the place doing the work that interns and residents used to do. I get the appeal of the “work smarter, not harder” philosophy but I think it’s worth noting that we thought we were pretty smart, hard-working and efficient too. Medical education has definitely changed. Asynchronous learning, reverse classrooms, small groups, simulations, etc.. some of these advances are great and others not so much. I’m glad you and your attendings feel that your training is better than theirs was but I haven’t really appreciated that with the “finished product.” Confidence is definitely higher, but I haven’t seen that correlated with relevant clinical outcomes. Maybe I’m just jealous. I took a very intentional break from flying during residency because I didn’t feel I was in a place where I could do it safely. I took a BFR and ICC every two years (yes, I know they’re not called that anymore) and then wouldn’t fly again until the next one was due. I guess I didn’t want to give up on calling myself a pilot but knew I wasn’t safe and proficient to fly on my own. I’m glad you found a plane. I hope flying becomes a lifelong hobby for you and brings you all the joy and happiness it has brought me and others here. I also hope you realize your limitations and don’t become another statistic as has happened to many other intelligent, highly-educated, high-achieving individuals.

Well, Hank as far as I recall I haven’t told you to do anything and I’m definitely not a politician or reporter so I’m sure that was directed at someone else… There’s plenty of data out there - just pick up a copy of the Annals of Internal Medicine or NEJM and you’ll see plenty of COVID studies. If you’ve never taken a biology class though you may not be the most qualified to interpret those studies. As an engineer, though I’m sure you’ll agree that not everyone is equally qualified to interpret the raw data and it’s a little unrealistic to think that you can do it better than the experts. I regularly download my engine monitor data but I have no idea what I’m looking at — so I pay Savvy to do it. When I had to do a precautionary landing due to a rough running engine I sent them the data and asked them what was wrong, instead of trying to diagnose it myself based on my feelings, beliefs and social medial contacts. I fully support making your own decisions but when your life is at stake sometimes it helpful to listen to the experts when making those decisions. I sense the frustration, though. I’m frustrated too.

I actually agree with most of what you’re saying and thanks for calling me out as a Grumpy Old Man. I guess I’m just disappointed with the way things have changed. When I was a resident the expectation was that it was going to be really hard, you were going to learn a lot and by the time you finished residency you would know what you needed to know to be a good doctor. Now it seems a lot of emphasis is placed on lifestyles and making things easy and this translates into physician’s behavior after residency. In the past, if you had a surgery in the morning and had pain that night you would call the surgeon and they would try to help you. When I had shoulder surgery the surgeon gave me his cell phone number and said “If you have any questions, call me first.” Now, no one wants to be bothered with taking care of patients after hours so if you call the surgeon their answering service will simply tell you to “go to the ER.” So will the pediatrician if you tell them your kid has a fever or the family medicine doctor if you have a sore throat. It’s just sad to see the trend of doctors not wanting to take “ownership” of their patients and acting like shift workers instead of the way it used to be where doctors seemed to take pride on being there for the patient. I agree you have to be able to take care of yourself in order to take care of others (and perform your job well) but I think there is a balance and the pendulum has swung toward putting yourself first at the expense of the patient.

That has been proposed. There was a big movement to add an extra year to residency because of the experience lost with the work hour restrictions (but then that has huge effects in cost, throughout, etc..). There’s a popular stress vs. performance curve that shows that your performance increases with increased stress, up to a point. The goal is finding that point, teaching people how to manage stress and exposing them to as much as possible in a supervised environment (residency) before they encounter it for the first time on their own. As @KLRDMD aptly pointed out, when you get that trauma airway and you realize that either you’re going to control the airway or the patient is going to die right in front of you is a time when you’re very thankful for your past experience. I didn’t like taking call either, but standing in front of a critical patient and realizing that I was the one that needed to fix it taught me valuable skills. As a resident, someone is always being paid to help you and be available for you (I remind the residents about this all the time). As an attending, you’re often on your own. Whatever you fail to learn as a resident (and fellow) will be to your (and you’re patients) detriment after you finish your training. Residency was not fun. I did two. My wife did a fellowship as well and none of it was fun. That being said, we’ve both very appreciative of the training we received and the things I learned overnight in the hospital as a resident have saved my a$$ multiple times as an attending.

Lucky for him, he got all three!

Residency now isn’t what it used to be. No more “if you only take call q2 (every other day) you’ll miss half the good cases.” About 10-15 years ago they made a bunch of rules which they have continually refined to make residency kinder and gentler. I believe this had coincided with the expectations of a certain generation about how they should be treated. There are some patient safety concerns as well however the landmark case which lead to all this regulation likely wouldn’t have been prevented by work hour restrictions because plenty of well-rested residents would likely have made the same mistake and by restricting work hours you restrict the amount of time residents gain experience leading to residents graduating with less experience than their predecessors (https://psnet.ahrq.gov/primer/duty-hours-and-patient-safety). Sorry if that’s a bit of a rant. I understand the reasons for the restrictions but those of us who have trained and taught during the transition have definitely seen a change in behavior and knowledge after the changes took place. When I was an internal medicine intern you were expected to know EVERYTHING about YOUR patient. If the attending asked you if the patient had any pets, you were supposed to know the answer (including how many, what type, and whether they were indoors or outdoors - bonus points if you knew the pet names). I remember as a hospitalist attending after the transition when they had eliminated overnight call for interns (in my opinion, the single most valuable experience of internship) I asked one of the interns a question about his patient - unapologetically, he replied “I don’t know. I just got him this morning. He’s not my patient.” I asked him “Well, if he’s not your patient then whose patient is he?” He replied “yours?” We had a discussion after that. I guess what I’m trying to say is that as a surgical resident it’s very likely that he does have time to fly. He will also have the income to support buying and maintaining an airplane. Hopefully he has the judgement to do it safely. When I took my commercial check ride the DPE commented afterwards “I’m really surprised your a doctor. You’re the first one I’ve flown with that has any common sense.”

I remember so many great saying from my surgery rotation such as: “eat when you can, sleep when you can and don’t (mess) with the pancreas” as well as “just because you CAN do something doesn’t mean you SHOULD.” I’m sure you can find someone to lend you the money and get a plane, but as @KLRDMDpointed out, having access to a plane may not improve your life expectancy. If you’re new to flying and have places that you “need” to get to then you will probably put yourself in some dangerous situations. With small planes, you always need a Plan B. Personally, I commute to work in my plane and 90% of the time I end up flying. But not at night, or after seeing patients all day, or if I’m tired, or if the weather is bad, or if I don’t feel good. Get-home-itis isn’t a real medical disease but it’s one of the leading causes of death of pilots. Sorry to turn your financial question into unsolicited life advice but I like having vascular surgeons answer the phone when I call so I’d like to keep as many around as possible.

Not the question you asked, but my answer would be to pay off your student loans before getting an airplane. Part of the deal I made with my wife was that I wouldn’t take out a loan for my hobby. Have you checked out this site? https://www.whitecoatinvestor.com